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Ann Thorac Surg 1996;62:90
© 1996 The Society of Thoracic Surgeons

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Discussion

Discussion

See also page 83.

DR SAFUH ATTAR (Baltimore, MD): Doctor Riordan, have you used this information in your clinical applications?

DR RIORDAN: Yes. We have been very impressed with the usefulness of the systemic venous oxygen saturation catheters. We have been placing a 4F oximetric catheter (Abbott Biomedical, North Chicago, IL) in our recent series of children with hypoplastic left heart syndrome, and we have found it adds useful information that dramatically changes our clinical results. We have also stopped using dobutamine in these children and have been using epinephrine instead.

DR ATTAR: Did you have to alter the dosage pertinent to your studies?

DR RIORDAN: Rather than altering specific dosages, we have found that the oximetric catheters allow us to titrate therapy. When using inotropic agents, or adding supplemental nitrogen or carbon dioxide in the ventilator circuit, we adjust dosages to improve SVO₂. This has been valuable enough to us that we have started to place the catheters preoperatively to stabilize our patients, and have been able to improve a number of patients substantially this way.

DR CONSTANTINE MAVROUDIS (Chicago, IL): This is a very well presented and thoughtful paper. We really need to have more studies like this comparing hemodynamic parameters under varying conditions of hypothermia, drug therapy, and systemic-to-pulmonary artery communications. Systemic-to-pulmonary artery shunts performed for complex heart disease and pulmonary stenosis/atresia usually have a good outcome. However, when cardiopulmonary bypass is necessary for other intracardiac problems, the shunt may not perform as well due to the increase in pulmonary artery pressure. Have you done any experiments to address this very difficult clinical problem?

I enjoyed this presentation very much. I think you have another 10 years of experimenting with this model, and I look forward to the results.

DR RIORDAN: Thank you, Dr Mavroudis, for the kind comments. We have not performed cardiopulmonary bypass yet in these animals. This was technically not an easy model to develop and was designed not to require cardiopulmonary bypass to make a more reproducible model. Of the two other animal models of a univentricular heart, Dr Norwood's group has one that is constructed on cardiopulmonary bypass. We are planning to use our model for more complex situations in the future and will be adding cardiopulmonary bypass at that point. As you mentioned, there are a number of interventions we wish to do before adding bypass.

Related Article

Inotropes in the Hypoplastic Left Heart Syndrome: Effects in an Animal Model

Christopher J. Riordan, Flemming Randsbaek, John H. Storey, William D. Montgomery, William P. Santamore, and Erle H. Austin, III
Ann. Thorac. Surg. 1996 62: 83-90. [Abstract] [Full Text]

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content Related Collections Related Article